Sec. 104. Grants to States, Indian Tribes or Tribal organizations, and public or private agencies and organizations

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Section 105 of the Child Abuse Prevention and Treatment Act ( 42 U.S.C. 5106 ) is amended to read as follows: The Secretary may award grants, and enter into contracts, for programs and projects in accordance with this section, for any of the following purposes: Capacity building, in order to create coordinated, inclusive, and collaborative systems that have statewide impact in preventing, reducing, and treating child abuse and neglect. Innovation, through time-limited, field-initiated demonstration projects that further the understanding of the field to reduce child abuse and neglect.

Plans of safe care grants to improve and coordinate State responses to ensure the safety, permanency, and well-being of infants affected by substance use. The Secretary may award grants or contracts to an eligible entity that is a State or local agency, Indian Tribe or Tribal organization, a nonprofit entity, or a consortium of such entities. To be eligible to receive a grant or contract under this section, an entity shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.

An eligible entity receiving a grant or contract under this subsection shall use the grant funds to better align and coordinate community-based, local, and State activities to strengthen families and prevent child abuse and neglect, by— training professionals in prevention, identification, and treatment of child abuse and neglect, which may include— training of professional and paraprofessional personnel in the fields of health care, medicine, law enforcement, judiciary, social work and child protection, education, early childhood care and education, and other relevant fields, or individuals such as court appointed special advocates (CASAs) and guardian ad litem, who are engaged in, or intend to work in, the field of prevention, identification, and treatment of child abuse and neglect, including the links between child abuse and neglect and domestic violence, and approaches to working with families with substance use disorder; training on evidence-based and evidence-informed programs to improve child abuse and neglect reporting by adults, with a focus on adults who work with children in a professional or volunteer capacity, including on recognizing and responding to child sexual abuse; training of personnel in best practices to meet the unique needs and development of special populations of children, including those with disabilities, and children under age of 3, including promoting interagency collaboration; improving the training of supervisory child welfare workers on best practices for recruiting, selecting, and retaining personnel; enabling State child welfare and child protection agencies to coordinate the provision of services with State and local health care agencies, substance use disorder prevention and treatment agencies, mental health agencies, other public and private welfare agencies, and agencies that provide early intervention services to promote child safety, permanence, and family stability, which may include training on improving coordination between agencies to meet health evaluation needs of children who have been victims of substantiated cases of child abuse or neglect; training of personnel in best practices relating to the provision of differential response; or training for child welfare professionals to reduce and prevent discrimination (including training related to implicit biases) in the provision of child protection and welfare services related to child abuse and neglect; enhancing systems coordination and triage procedures, including information systems, for responding to reports of child abuse and neglect, which include programs of collaborative partnerships between the State child protective services agency, community social service agencies and community-based family support programs, law enforcement agencies and legal systems, developmental disability agencies, substance use disorder treatment agencies, health care entities, domestic violence prevention entities, mental health service entities, schools, places of worship, and other community-based agencies, such as children's advocacy centers, in accordance with all applicable Federal and State privacy laws, to allow for the establishment or improvement of a coordinated triage system; or building coordinated community-level systems of support for children, parents, and families through prevention services in order to strengthen families and connect families to the services and supports relevant to their diverse needs and interests, including needs related to substance use disorder prevention.

The Secretary may award grants to entities that are States or local agencies, Indian Tribes or Tribal organizations, or public or private agencies or organizations (or combinations of such entities) for field-initiated demonstration projects of up to 5 years that advance innovative approaches to prevent, reduce, or treat child abuse and neglect. To be eligible to receive a grant under this section, an entity shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require, including a rigorous methodological approach to the evaluation of the grant.

An entity that receives a grant under this section shall use the funds made available through the grant to carry out or bring to scale promising, evidence-informed, or evidence-based activities to prevent, treat, or reduce child abuse and neglect that shall include one or more of the following: Multidisciplinary systems of care to strengthen families and prevent child abuse and neglect, including primary prevention programs or strategies aimed at reducing the prevalence of child abuse and neglect.

Projects for the development of new research-based strategies for risk and safety assessments and ongoing evaluation and reassessment of performance and accuracy of existing risk and safety assessment tools, including to improve practices utilized by child protective services agencies, which may include activities to reduce and prevent bias in such practices. Projects that involve research-based strategies for innovative training for mandated child abuse and neglect reporters, which may include training that is specific to the mandated individual’s profession or role when working with children.

Projects to improve awareness of child welfare professionals and volunteers in the child welfare system and the public about— child abuse or neglect under State law; the responsibilities of individuals required to report suspected and known incidents of child abuse or neglect under State law, as applicable; and the resources available to help prevent child abuse and neglect. Programs that promote safe, family-friendly physical environments for visitation and exchange— for court-ordered, supervised visitation between children and abusing parents; and to facilitate the safe exchange of children for visits with noncustodial parents in cases of domestic violence.

Innovative programs, activities, and services that are aligned with the research priorities identified under section 104(a)(4). Projects to improve implementation of best practices to assist medical professionals in identifying, assessing, and responding to potential abuse in infants, including regarding referrals to child protective services as appropriate and identifying injuries indicative of potential abuse in infants, and to assess the outcomes of such best practices. The Secretary is authorized to make grants to States for the purpose of assisting child welfare agencies, social services agencies, substance use disorder treatment agencies, hospitals with labor and delivery units, medical staff, public health and mental health agencies, and maternal and child health agencies to facilitate collaboration in developing, updating, implementing, and monitoring plans of safe care described in section 106(b)(2)(B)(iii).

Section 112(a)(2) shall not apply to the program authorized under this paragraph. Of the amounts made available to carry out paragraph (1), the Secretary shall reserve— no more than 3 percent for the purposes described in paragraph (7); and up to 3 percent for grants to Indian Tribes and Tribal organizations to address the needs of infants born with, and identified as being affected by, substance abuse or withdrawal symptoms resulting from prenatal drug exposure or a fetal alcohol spectrum disorder and their families or caregivers, which to the extent practicable, shall be consistent with the uses of funds described under paragraph (4).

The Secretary shall allot the amount made available to carry out paragraph

(1)that remains after application of subparagraph

(A)to each State that applies for such a grant, in an amount equal to the sum of— $500,000; and an amount that bears the same relationship to any funds made available to carry out paragraph

(1)and remaining after application of subparagraph (A), as the number of live births in the State in the previous calendar year bears to the number of live births in all States in such year. If the amount made available to carry out paragraph

(1)is insufficient to satisfy the requirements of subparagraph (B), the Secretary shall ratably reduce each allotment to a State. A State desiring a grant under this subsection shall submit an application to the Secretary at such time and in such manner as the Secretary may require. Such application shall include— a description of— the impact of substance use disorder in such State, including with respect to the substance or class of substances with the highest incidence of abuse in the previous year in such State, including— the prevalence of substance use disorder in such State; the aggregate rate of births in the State of infants affected by substance abuse or withdrawal symptoms or a fetal alcohol spectrum disorder (as determined by hospitals, insurance claims, claims submitted to the State Medicaid program, or other records), if available and to the extent practicable; and the number of infants identified, for whom a plan of safe care was developed, and for whom a referral was made for appropriate services, as reported under section 106(d)(18); the challenges the State faces in developing, implementing, and monitoring plans of safe care in accordance with section 106(b)(2)(B)(iii); the State’s lead agency for the grant program and how that agency will coordinate with relevant State entities and programs, including the child welfare agency, the substance use disorder treatment agency, hospitals with labor and delivery units, health care providers, the public health and mental health agencies, programs funded by the Substance Abuse and Mental Health Services Administration that provide substance use disorder treatment for women, the State Medicaid program, the State agency administering the block grant program under title V of the Social Security Act ( 42 U.S.C. 701 et seq.), the State agency administering the programs funded under part C of the Individuals with Disabilities Education Act ( 20 U.S.C. 1431 et seq.), the maternal, infant, and early childhood home visiting program under section 511 of the Social Security Act ( 42 U.S.C. 711 ), the State judicial system, and other agencies, as determined by the Secretary, and Indian Tribes and Tribal organizations, as appropriate, to implement the activities under this paragraph; how the State will monitor local development and implementation of plans of safe care, in accordance with section 106(b)(2)(B)(iii)(II), including how the State will monitor to ensure plans of safe care address differences between substance use disorder and medically supervised substance use, including for the treatment of a substance use disorder; if applicable, how the State plans to utilize funding authorized under part E of title IV of the Social Security Act ( 42 U.S.C. 670 et seq.) to assist in carrying out any plan of safe care, including such funding authorized under section 471(e) of such Act (as in effect on October 1, 2018) for mental health and substance abuse prevention and treatment services and in-home parent skill-based programs and funding authorized under such section 472(j) (as in effect on October 1, 2018) for children with a parent in a licensed residential family-based treatment facility for substance abuse; and an assessment of the treatment and other services and programs available in the State to effectively carry out any plan of safe care developed, including identification of needed treatment, and other services and programs to ensure the well-being of young children and their families affected by substance use disorder, such as programs carried out under part C of the Individuals with Disabilities Education Act ( 20 U.S.C. 1431 et seq.) and comprehensive early childhood development services and programs such as Head Start programs; a description of how the State plans to use funds for activities described in paragraph

(4)for the purposes of ensuring State compliance with requirements under clauses

(ii)and

(iii)of section 106(b)(2)(B); and an assurance that the State will comply with requirements to refer a child identified as substance-exposed to early intervention services as required pursuant to a grant under part C of the Individuals with Disabilities Education Act ( 20 U.S.C. 1431 et seq.). Funds awarded to a State under this subsection may be used for the following activities, which may be carried out by the State directly, or through grants or subgrants, contracts, or cooperative agreements: Improving State and local systems with respect to the development and implementation of plans of safe care, which— shall include parent and caregiver engagement, as required under section 106(b)(2)(B)(iii)(I), regarding available treatment and service options, which may include resources available for pregnant, perinatal, and postnatal women; and may include activities such as— developing policies, procedures, or protocols for the administration or development of evidence-based and validated screening tools for infants who may be affected by substance use withdrawal symptoms or a fetal alcohol spectrum disorder and pregnant, perinatal, and postnatal women whose infants may be affected by substance use withdrawal symptoms or a fetal alcohol spectrum disorder; improving assessments used to determine the needs of the infant and family; improving ongoing case management services; improving access to treatment services, which may be prior to the pregnant woman’s delivery date; and keeping families safely together when it is in the best interest of the child. Developing policies, procedures, or protocols in consultation and coordination with health professionals, public and private health facilities, and substance use disorder treatment agencies to ensure that— appropriate notification to child protective services is made in a timely manner, as required under section 106(b)(2)(B)(ii); a plan of safe care is in place, in accordance with section 106(b)(2)(B)(iii), before the infant is discharged from the birth or health care facility; and such health and related agency professionals are trained on how to follow such protocols and are aware of the supports that may be provided under a plan of safe care. Training health professionals and health system leaders, child welfare workers, substance use disorder treatment agencies, and other related professionals such as home visiting agency staff and law enforcement in relevant topics including— State mandatory reporting laws established under section 106(b)(2)(B)(i) and the referral and process requirements for notification to child protective services when child abuse or neglect reporting is not mandated; the co-occurrence of pregnancy and substance use disorder, and implications of prenatal exposure; the clinical guidance about treating substance use disorder in pregnant and postpartum women; appropriate screening and interventions for infants affected by substance use disorder, withdrawal symptoms, or a fetal alcohol spectrum disorder and the requirements under section 106(b)(2)(B)(iii); and appropriate multigenerational strategies to address the mental health needs of the parent and child together. Establishing partnerships, agreements, or memoranda of understanding between the lead agency and other entities (including health professionals, health facilities, child welfare professionals, juvenile and family court judges, substance use and mental disorder treatment programs, early childhood education programs, maternal and child health and early intervention professionals (including home visiting providers), peer-to-peer recovery programs such as parent mentoring programs, and housing agencies) to facilitate the implementation of, and compliance with, section 106(b)(2) and subparagraph

(B)of this paragraph, in areas which may include— developing a comprehensive, multi-disciplinary assessment and intervention process for infants, pregnant women, and their families who are affected by substance use disorder, withdrawal symptoms, or a fetal alcohol spectrum disorder, that includes meaningful engagement with and takes into account the unique needs of each family and addresses differences between medically supervised substance use, including for the treatment of substance use disorder, and substance use disorder; ensuring that treatment approaches for serving infants, pregnant women, and perinatal and postnatal women whose infants may be affected by substance use, withdrawal symptoms, or a fetal alcohol spectrum disorder, are designed to, where appropriate, keep infants with their mothers during both inpatient and outpatient treatment; and increasing access to all evidence-based medication-assisted treatment approved by the Food and Drug Administration, behavioral therapy, and counseling services for the treatment of substance use disorders, as appropriate. Developing and updating systems of technology for improved data collection and monitoring under section 106(b)(2)(B)(iii), including existing electronic medical records, to measure the outcomes achieved through the plans of safe care, including monitoring systems to meet the requirements of this Act and submission of performance measures. Each State that receives funds under this subsection, for each year such funds are received, shall submit a report to the Secretary, disaggregated by geographic location, economic status, and major racial and ethnic groups, except that such disaggregation shall not be required if the results would reveal personally identifiable information on, with respect to infants identified under section 106(b)(2)(B)(ii)— the number who experienced removal associated with parental substance use; the number who experienced removal and subsequently are reunified with parents, and the length of time between such removal and reunification; the number who are referred to community providers without a child protection case; the number who receive services while in the care of their birth parents; the number who receive post-reunification services within 1 year after a reunification has occurred; and the number who experienced a return to out-of-home care within 1 year after reunification. The Secretary shall submit an annual report to the Committee on Health, Education, Labor, and Pensions and the Committee on Appropriations of the Senate and the Committee on Education and Labor and the Committee on Appropriations of the House of Representatives that includes the information described in paragraph

(5)and recommendations or observations on the challenges, successes, and lessons derived from implementation of the grant program. The Secretary shall use the amount reserved under paragraph (2)(A)(i) to provide written guidance and technical assistance to support States in complying with and implementing this paragraph, which shall include— technical assistance, including programs of in-depth technical assistance, to additional States, territories, and Indian Tribes and Tribal organizations in accordance with the substance-exposed infant initiative developed by the National Center on Substance Abuse and Child Welfare; guidance on the requirements of this Act with respect to infants born with, and identified as being affected by, substance use or withdrawal symptoms or fetal alcohol spectrum disorder, as described in clauses

(ii)and

(iii)of section 106(b)(2)(B), including by— enhancing States’ understanding of requirements and flexibilities under the law, including by clarifying key terms; addressing State-identified challenges with developing, implementing, and monitoring plans of safe care, including those reported under paragraph (3)(A)(ii); disseminating best practices on implementation of plans of safe care, on such topics as differential response, collaboration and coordination, and identification and delivery of services for different populations, while recognizing needs of different populations and varying community approaches across States; and helping States improve the long-term safety and well-being of young children and their families; supporting State efforts to develop information technology systems to manage plans of safe care; and preparing the Secretary’s report to Congress described in paragraph (6). The authority under this subsection shall sunset on September 30, 2023. In making grants or entering into contracts for projects under this section, the Secretary shall require all such projects to report on the outcomes of such activities. Funding for such evaluations shall be provided either as a stated percentage of a demonstration grant or as a separate grant or contract entered into by the Secretary for the purpose of evaluating a particular demonstration project or group of projects. In the case of an evaluation performed by the recipient of a grant, the Secretary shall make available technical assistance for the evaluation, where needed, including the use of a rigorous application of scientific evaluation techniques. .

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Sec. 104

Grants to States, Indian Tribes or Tribal organizations, and public or private agencies and organizations

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